CHICAGO – Coinciding with the U.S. Department of Health and Human Services’ event Friday commemorating Black Maternal Health Week, the American Medical Association (AMA) released recommendations (PDF) that the Administration can take to improve maternal health outcomes.

To bolster the Administration’s efforts to advance maternal health, the AMA worked collaboratively over the last year with numerous members of the Federation of Medicine, including relevant specialty societies, state medical associations, and physicians from rural areas.

“We appreciate the Administration’s action on this worsening problem that is immune to easy fixes and simple remedies. The Administration has correctly noted that the maternal health crisis is at the intersection of multiple complex issues, including health equity, adequate access to health care, socioeconomic factors, and more making the maternal health crisis an issue that will require large systemic changes to successfully address,” said AMA President Jesse M. Ehrenfeld, M.D., MPH.

More women in the die in the U.S. from pregnancy-related complications than in any other developed country. According to the Centers for Disease Control and Prevention, about 1,205 pregnancy-related deaths occurred in 2021, and 80 percent of these deaths were preventable. Major disparities in maternal mortality exist, with Black women three to four times more likely than non-Hispanic White women to die due to pregnancy-related complications and American Indian or Alaska Native women more than twice as likely than non-Hispanic White women to die due to pregnancy-related complications. The AMA believes the federal government should take concrete actions to reduce and prevent rising rates of maternal mortality and serious or near-fatal maternal morbidity.

Among the AMA’s recommendations:

• Promote telehealth and home monitoring during pregnancy and the postpartum period and address barriers to providing remote patient care. Hypertensive disorders of pregnancy are one of the leading causes of pregnancy-related deaths that occur in the first six weeks after delivery. The AMA encourages the Administration to help ensure comprehensive Medicaid coverage of virtual maternal health care services.

• Provide the financial resources necessary to implement the practices recommended by the Alliance for Innovation for Maternal Health and seek input from physicians providing obstetrical services about the barriers to implementing these patient safety bundles.

• Grow and retain the physician workforce to provide complex care to higher risk pregnant, birthing and postpartum patients. This includes increasing compensation for Indian Health Service (IHS) physicians as well as increasing funding for the IHS Maternal Child Health program to increase access to OBGYNs and maternal-fetal medicine specialists. Also, there should be additional funding for Teaching Health Center Graduate Medical Education Programs and for the National Health Service Corps as well as expanded maternal care education and training, especially to those physicians who administer care to pregnant or postpartum individuals but are not OBGYNs or maternal-fetal medicine specialists. To help with the retention of physicians who provide maternal care, the Administration should work to remove the cap on physician residency slots. If this is not possible, the Administration should work to increase the cap on physician residency slots and ensure that the cap is not stagnant but is increased as needed.

• Fund holistic simulations that can improve maternal health and be made available for every physician and physician-led team that engages in maternal care, including OBGYNs, maternal-fetal medicine specialists, family physicians, and emergency medicine physicians.

• Implement recommendations of the HHS Interagency Pain Management Best Practices Task Force, which highlight pregnant women as a special population.

• Expand the Maternal Health and Obstetrics Pathway and ensure that additional maternal health pathways can be created for rural and urban training for OBGYNs, maternal-fetal medicine specialists, family physicians, and other physicians who likely will have to provide maternal care.

• Increase payments for Medicaid programs and commercial insurance plans for maternity care services, particularly services for individuals with complex needs and those who have difficulty accessing and utilizing traditional services.

• Change the payment system for rural hospitals. More than one-third of the rural hospitals that still have labor and delivery services are losing money on patient services overall, putting their ability to continue delivering maternity care at risk. Moreover, the number of providers that are needed to maintain labor and delivery units, such as physicians, nurses, and anesthesiologists, are costly. As a result, payments per birth that are adequate at a large hospital are not enough to support maternity care at small rural hospitals with far fewer births.